RURAL ROTATION Or RTT RESIDENT SUPPORT GRANT EVALUATION

Rural Rotation/RTT Evaluation1

RURAL ROTATION or RTT RESIDENT SUPPORT GRANT EVALUATION

Grant recipients of the State funded Wisconsin Rural Physician Residency Assistance Program (WRPRAP) are obliged to report in a timely manner the purpose and disposition of their awards, the results of their efforts and a self-assessment of outcomes achieved. For RTT’s,generally, a report is expected: 1) when six months of your grant period has elapsed; and 2) an updated version of the same report within 30 days after conclusion of the grant period. For community-based rotations, evaluations are due within 30 days of completion of each rotation segment.

WRPRAP awards are made in various categories and reporting forms are specific to category. This form is for reporting results of a rural rotation OR the experience of an individual resident in a RTT (Rural Training Track).

• A rotation is a limited experience* in a rural site for a resident from any eligible residency program to complete a required or elective curriculum component.
• An RTT may receive WRPRAP support for a future physician completing his residency training in the RTT.

* A WRPRAP-funded rotation must be a minimum of eight weeks. When these weeks are not consecutive, an evaluation report is expected at the conclusion of each site experience (3 weeks, 4 weeks, etc.) within 21 days of completion of that rotation.

Please report your results succinctly and honestly. Use as much space as you need for each question. You may also add comments on unsolicited information.

Program Information
Your Name
Today’s Date
Recipient Organization
Name of Project
Date Grant Awarded
Grant Period / from / to
Amount Awarded / $
Program Director (or primary contact)
Resident(s)
Principle Participating Individuals
Site of Resident Experience (separate form for each site)

Results Summary
Stated Grant Goals(as submitted ingrant application):
Budget Proposal(as submitted ingrant application):
Actual expenditures by type and amount:
Please describe how and to what extent you met your goals by clearly showing your accomplishments with this funding(not to exceed one page):
What unanticipated challenges and barriers presented themselves over the course of the grant? How were these addressed and to what effect?
Are there unmet goals in your grant intentions? Please explain.
How did your program contribute to WRPRAP’s primary goal of increasing the number of opportunities for physician training in rural settings?

Resident Experience
Resident EHR logs can be used to report the following kinds of information.
Weeks completed:
Weeks remaining in 8-week rotation obligation:
To be completed when?
Where ?
(RTT Not Applicable)
Number of Patients Seen
Ave. Per Day: / In hospital setting (total): / Independent:
Ave. Per Wk: / In clinical setting (total): / With preceptor:
TOTAL:
Primary Diagnoses seen:
Types of care given:
Duty Hours/Clinic (how many, when):
Duty Hours/Hospital (how many, when):

Qualitative Assessment
Due at end of rotation only – or after each segment if not same site or preceptors
Program Director’s (or Designee’s) Comments:
Preceptor satisfaction with the experience:
Staff evaluation of resident performance:
Patient impressions of resident:
Resident’s comments about understanding of rural health as a result of this rotation:
If this is the resident’s final rotation under this grant, resident’s assessment of the cumulative experience, comparing both rotations and evaluating the overall learning experience.
How has this rotation experience affected resident’s inclination to practice in a rural setting?

Program Director’s (or Designee’s) Printed Name

______

Signature - Program Director (or Designee)Date

Submission Instructions

Reports can be submitted as attachments via email to or mailed to

WRPRAP

1100 Delaplaine Court

Alumni Hall 2820

Madison, WI 53715

Thank you very much for your assistance with this evaluation effort!